Chordomas: their CT appearance in the cervical, thoracic and lumbar spine.

Abstract

We reviewed 25 CT scans of 21 patients who had chordomas in the cervical, thoracic, or lumbar spine. Nine patients were studied at the time of initial presentation and 12 after tumor recurrence. All scans showed vertebral body destruction coupled with an associated soft tissue mass located anteriorly or laterally. Additional CT findings included septated areas of low attenuation within the tumor, amorphous soft tissue calcification, tumor extension into the spinal canal, disk space involvement, and contrast enhancement.

Chordoma of the Thoracic Spine. Case Report.

“…neoplasms consisting of large mucus-containing physaliphorous (large vacuolated) cells and their precursors (elongated epithelioid); whereas other types of chordomas have atypical, epithelioid, or spindle cell or chondroid features. 5,34) The light and electron microscopy appearance and immunostaining and ultrastructural findings are entirely similar, 22,23,28) but classical malignant chordomas, like our case, must be distinguished from other types of chordomas since they are considered to have different biological behaviors. 28,33) Long-term clinical follow up is usually needed to identify the nature of the chordoma.…”

“…2,12,23,30) CT clearly demonstrates ivory vertebral body 30) and paravertebral tumor, 2,12,13,23,25,30) intraspinal extension, 13,23,27) and disc space involvement. 13,23) Contrast enhancement is mild to moderate 17) and heterogeneous (mottled). 13,23) Septated areas of low attenuation within the tumor 12,23,31) or multiple zones of hypodensity-correlating areas of cystic degeneration 13) may be present.…”

“…8,29,31,34) Chordomas are well demarcated from the soft tissue due to the fibrous pseudocapsule, 12,30) but have elusive margins in bone. 12,31) Radiography shows osteolytic lesions in the vertebral body, extension into the adjacent vertebra destroying the intervening disk space, 2,8,13,23,24,33) secondary reactive osteosclerosis 2) (not osteoblastic activity but vertebral collapse 32) ), and characteristic amorphous soft tissue calcifications 2,31,32,34) or ossifications. 2,12,23,30) CT clearly demonstrates ivory vertebral body 30) and paravertebral tumor, 2,12,13,23,25,30) intraspinal extension, 13,23,27) and disc space involvement.…”

“…13,23) Contrast enhancement is mild to moderate 17) and heterogeneous (mottled). 13,23) Septated areas of low attenuation within the tumor 12,23,31) or multiple zones of hypodensity-correlating areas of cystic degeneration 13) may be present. MR imaging shows epidural extension, compression, 2,8,31) and epidural metastasis.…”

MR Imaging Grading System for Skull Base Chordoma

“…15 Conventional chordoma is the most common type, and patients with chondroid chordoma are reported to have the best prognoses. 8 Chordoma often shows low density and bone destruction on CT. 16 MR imaging is superior in detecting the tumor and delineating its extent. 17 Chordomas have a highly heterogeneous appearance on MR imaging, demonstrating hypoto isointensity on T1 sequences and moderate-to-very-high intensity on T2 sequences.…”